Antidepressants and gestational diabetes

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In a first-of-its-kind study, Canadian researchers have found that use of some antidepressants during pregnancy increases risk of gestational diabetes mellitus (GDM) and the longer the use, the greater the risk. Published in BMJ Open, the results are from a nested case-control study using data from pregnant women with 17 years of follow-up.

With the research, the authors aimed to determine whether specific classes, types and duration of use of antidepressants in pregnancy were associated with GDM. The data analyzed were from the Quebec Pregnancy Cohort (QPC), a Canadian provincial database that includes prospectively collected information on all pregnancies and children from January 1998 to December 2015.

Of the 20,905 cases and 209,050 matched controls, 4.2% were exposed to antidepressants. Among the the classes of antidepressants that researchers looked at were selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). They also assessed exposure specifically to citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, and amitriptyline. The durations of exposure assessed were ≤90 days (short), 90 to <180 days (medium), and ≥180 days (long). Confounders considered were sociodemographic variables and material characteristics, maternal comorbidities, and healthcare services utilization and co-medication.

After adjustment for potential confounders, antidepressant use was found to be associated with an increased risk of GDM (aOR 1.19, 95% CI 1.08 to 1.30). A similar association was seen for exposure to venlafaxine (aOR 1.27, 95% 1.09 to 1.49) (27% increased risk) and amitriptyline (aOR 1.52, 95% CI 1.25 to 1.84)(52% increased risk). Risk of GDM was increased by 15%, 17%, and 29%, respectively, for short, medium, and long exposure to antidepressants, specifically for SNRIs, TCAs, and for combined use of two classes of antidepressant classes. No statistically significant association was observed for any SSRI.

The authors said their results “raise awareness of the risk of GDM with the use of specific antidepressants during pregnancy,” while noting that more studies are needed to replicate the findings.